Affidavit of Proprietor/ Partners/ Director(s)/ Managing Director

(Performa to be submitted on Rs 10/- Non-judicial Stamp paper duly attested by the Notary
Public)

I, ------------------ S/O, D/O Shri ------------------, Age ---------, Caste ------------, Resident
of -------------------------------------------------------- declare solemnly on oath as under:-

1) That I am proprietor/partner/Managing Director/ Director of M/s -------------------------, (Name

& Complete Address of manufacturing site) --------------------- by whom an application for
grant of manufacturing licenses for manufacturing Homoeopathic medicines has been made on
Form No. 24 C to the Licensing Authority and Drugs
Controller, Rajasthan under the provision of Drugs & Cosmetics Act, 1940 and Rules, 1945.

2) That following are the other Partners/ Directors of the firm:-

S.No. Name(s)& Father’s name Age Residential address

3) That the building in which manufacturing activities are proposed are taken on rent/ lease from
----------------------------/ are own premises which are adapted as per Schedule M I of the said
rules.

4) That adequate qualified technical staff has already been appointed as per site Master file &
other documents submitted along with the application.

5) That I will be solely responsible for the conduct of day-to-day activities of the firm for the
purpose of Section 34 of the said Act as well as other prevailing enactments established by Law
of Government of India & shall abide by all the provisions of Drugs & Cosmetics Act 1940 as
amended from time to time.

(DEPONENT)
( Name)

Witness No. 1 --------------------- Witness No. 2 ---------------------

(Signature, Name and Address) (Signature, Name and Address)

VERIFICATION

I, ----------------------------- verify that the contents of para 1 to 5 of this affidavit are true to the best of my
knowledge and belief. So GOD help me.

Date ------------------
Place --------------------- (DEPONENT)